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PREOPERATIVE PHASE

Nursing Health History


Definition The data collected by the nurse from the patient prior to the latters physical examination Objective To establish rapport with the patient and family Elements Client's overall health status Course of the present illness (including symptoms) Current management of illness Client's medical history (including familial medical history), social history Clients perception of his or her illness

Nursing Assessment
Definition Gathering of information about a patient's physiological, psychological, sociological, and spiritual status Includes physical examination or the observation and measurement of signs (objective data) or symptoms (subjective data) Physiological Examination Techniques Inspection Auscultation Percussion Palpation

Laboratory Examinations Normal Values (Complete Blood Count)


HGB 120 170 g/L RBC 4.0 6.0 X 1012 / L HCT 0.37 0.54 MCV 87 + - 5 U3 MCHC 34 + - 2 g/dL RDW 11.6 14.6 MPV 7.4 10.4 PLATELET 150 450 X 109/L WBC 4.5 10.0 X 109/L

Laboratory Examinations Normal Values (Urinalysis)


Color Straw Colored Transparency Clear pH 7.0 Specific Gravity 1.015 Albumin Negative Sugar Negative Leukocytes Negative Erythrocytes Negative Bilirubin Negative Nitrite Negative Ketones Negative Urobiligen Negative

Laboratory Examinations Normal Values (Fecalysis)


Color Dark Brown Consistency Formed Ova and Parasites Negative

Diagnostic Procedures (Ultrasound of LGBP)


Definition A diagnostic procedure wherein pictures of the abdominal organs are taken with sound waves and not x-rays. Purpose To determine the presence of stones in the gallbladder Preprocedural Health Teaching NPO 8 10 hours before the test Postprocedural Health Teaching Continue with Regular Diet

Cardiopulmonary Clearance (Chest X-Ray)


Definition An x-ray of the chest, lungs, heart, large

arteries, ribs, and diaphragm.


Purpose To examine the lungs for any kind of abnormalities

Cardiopulmonary Clearance (Electrocardiography - ECG)


Definition A test that translates the hearts electrical activity into line tracings on paper Purpose To check for problems with the electrical activity of the heart

Informed Consent
Definition It is a legal document that explains the tests, treatments, or procedures that will be performed on the patient and a means that the patient understands what will be done and can make decisions about what he or she wants Nursing Interventions Make sure patient must be able to understand the risks and benefits of what will be done prior to signing of the consent form and that all patients questions are answered

Nothing Per Orem


Health Teachings Avoid eating and drinking 8 10 hours before surgery. Purpose

Preoperative Medication (Unasyn 1.5g / IV TID)


Generic Name Ampicillin / Sulbactam Brand Name Pfizer Routes Intravenous Indications To reduce the incidence of postoperative wound infections in patients undergoing abdominal surgery. Contraindications and Cautions Individuals with a history of an allergic reaction to any of the Penicillins

POSTOPERATIVE PHASE

Nursing Goals for Postoperative Patients


Maintain adequate Respiratory function Maintain Cardiovascular function Promote comfort and safety Provide wound care Promotion of Normal Reflux Return

GOAL # 1: Maintaining Adequate Resp. Function


Rationale Anesthesia causes muscle relaxation which extends to the Pharynx leading to Respiratory Obstruction as Lower Jaw and falls backward while client is flat on bTongue ed. Nursing Interventions Maintain patent airway by assessing for respiratory parameters and performing suction as ordered Encourage the patient to promote lung expansion by teaching her how to perform Deep Breathing and Coughing Exercises and doing Incentive Spirometry

GOAL # 2: Maintaining Cardiovascular Function


Rationale Anesthetic agents have wide range of effects on the Cardiovascular System since these drugs contain intrinsic myocardial depressant. It causes cardiac depression and hemodynamic instability. Nursing Interventions Monitor the patients cardiovascular function by placing her on cardiac monitoring during stay in PACU and taking her vital signs every 15 minutes.

GOAL # 3: Promoting Comfort and Safety


Rationale Postoperative clients recovering from anesthesia may experience pain due to incision, prolonged surgical immobility and positioning. Nursing Interventions Assess for intensity and location of the pain Administer Pain Medications as ordered. Position patient into most comfortable position Check side rails, wheel locks on stretchers and stretcher safety belt.

GOAL# 4 Provide wound care


Rationale Wound or incision site in the postoperative period must be monitored to facilitate healing and avoid infections Nursing Interventions Check if dressing is dry and intact Assess wound edges, amount of bleeding, color and amount of drainage

GOAL # 5: Promoting Normal Reflex Return


Rationale Postoperative clients recovering from anesthesia may experience decreased level of movements. Nursing Interventions Determine the patients level of conscious ness and assess her ability to move her extremities using the Aldrette Scoring Guide. If the patient has full alertness and able to move all extremities, encourage early ambulation. If client has minimal consciousness and can barely control extremities, perform passive ROM.

Extremity Exercises
Definition: A technique of postoperative care in which a patient engages in slight and continuous movement of the upper and lower extremities in order to promote circulation of the blood Purpose To prevent the risk of clotting formation Health Teachings Encourage the client to do exercises every one to two hours when awake

Early Ambulation (Resumption of Activities)


Definition: A technique of postoperative care in which a patient gets out of bed and engages in light activity (sitting, standing, or walking) as soon as possible after an operation Purpose To promote the flow of oxygen throughout the body and strengthens the muscle tone. To speed up wound healing Health Teachings Begin light exercise (walking) immediately Take a shower or bath after 1 -2 days Drive a car after 3-4 days Avoid lifting objects exceeding 5 lbs. after surgery, usually for 1 week Resume sexual activity when desired

DISCHARGE TEACHINGS

Instruct the patent to perform incision care at home. Advice the patient to continue monitor for bowel problems Provide the patient information about her activity level. Remind the patient to see the doctor immediately if complications arise.

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